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Standardized referral form: Restricting client-centered practice?

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Summary

Standardizing community occupational therapists' (COTs) practice via referral forms impacts client-centered care. Findings suggest a need to address contextual barriers to ensure client needs remain central in homecare services.

Keywords:
community servicesdocumentationefficiencyhome care servicesinstitutional ethnographyneeds assessmentoccupational therapypatient-centered practicepractice contextqualitystandardization

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Area of Science:

  • Healthcare delivery
  • Occupational therapy
  • Health services research

Background:

  • Homecare efficiency in Québec is being enhanced through practice standardization.
  • The impact of standardization on client-centeredness for community occupational therapists (COTs) is unknown.
  • This study explores a referral form's role in standardizing COTs' practice.

Purpose of the Study:

  • To investigate the content and application of a referral form designed to standardize community occupational therapists' practices.
  • To understand how standardization influences the delivery of homecare services.

Main Methods:

  • An institutional ethnography approach was employed.
  • Data collection involved observations of work, interviews with 10 COTs, secondary informants, and document analysis.
  • Data were analyzed using institutional ethnography procedures.

Main Results:

  • The referral form, completed by colleagues, focuses on safety and autonomy in personal care and mobility.
  • The form structures COTs' workflow, including information gathering and client/caregiver interactions.
  • COTs function as consultants, assessing needs and recommending strategies for safe, long-term home living.

Conclusions:

  • The findings highlight potential impacts on COTs' client-centeredness, warranting serious consideration.
  • Health professionals must actively question and address contextual barriers hindering client-centered care.
  • Further efforts are needed to ensure homecare practices remain client-focused.